Prone position and positive end-expiratory pressure in acute respiratory distress syndrome.
Identifieur interne : 000482 ( Main/Exploration ); précédent : 000481; suivant : 000483Prone position and positive end-expiratory pressure in acute respiratory distress syndrome.
Auteurs : Marc Gainnier [France] ; Pierre Michelet ; Xavier Thirion ; Jean-Michel Arnal ; Jean-Marie Sainty ; Laurent PapazianSource :
- Critical care medicine [ 0090-3493 ] ; 2003.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Analyse de variance (MeSH), Circulation pulmonaire (MeSH), Compliance pulmonaire (MeSH), Décubitus dorsal (MeSH), Décubitus ventral (MeSH), Femelle (MeSH), France (épidémiologie), Gazométrie sanguine (MeSH), Humains (MeSH), Hémodynamique (MeSH), Indice de gravité de la maladie (MeSH), Modèles linéaires (MeSH), Mâle (MeSH), Radiographie (MeSH), Résultat thérapeutique (MeSH), Soins de réanimation (méthodes), Syndrome de détresse respiratoire de l'adulte (imagerie diagnostique), Syndrome de détresse respiratoire de l'adulte (mortalité), Syndrome de détresse respiratoire de l'adulte (métabolisme), Syndrome de détresse respiratoire de l'adulte (thérapie), Ventilation à pression positive (méthodes), Volume courant (MeSH), Études prospectives (MeSH).
- MESH :
- imagerie diagnostique : Syndrome de détresse respiratoire de l'adulte.
- mortalité : Syndrome de détresse respiratoire de l'adulte.
- métabolisme : Syndrome de détresse respiratoire de l'adulte.
- méthodes : Soins de réanimation, Ventilation à pression positive.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- épidémiologie : France.
- Adulte, Adulte d'âge moyen, Analyse de variance, Circulation pulmonaire, Compliance pulmonaire, Décubitus dorsal, Décubitus ventral, Femelle, Gazométrie sanguine, Humains, Hémodynamique, Indice de gravité de la maladie, Modèles linéaires, Mâle, Radiographie, Résultat thérapeutique, Volume courant, Études prospectives.
English descriptors
- KwdEn :
- Adult (MeSH), Analysis of Variance (MeSH), Blood Gas Analysis (MeSH), Critical Care (methods), Female (MeSH), France (epidemiology), Hemodynamics (MeSH), Humans (MeSH), Linear Models (MeSH), Lung Compliance (MeSH), Male (MeSH), Middle Aged (MeSH), Positive-Pressure Respiration (methods), Prone Position (MeSH), Prospective Studies (MeSH), Pulmonary Circulation (MeSH), Radiography (MeSH), Respiratory Distress Syndrome, Adult (diagnostic imaging), Respiratory Distress Syndrome, Adult (metabolism), Respiratory Distress Syndrome, Adult (mortality), Respiratory Distress Syndrome, Adult (therapy), Severity of Illness Index (MeSH), Supine Position (MeSH), Tidal Volume (MeSH), Treatment Outcome (MeSH).
- MESH :
- diagnostic imaging : Respiratory Distress Syndrome, Adult.
- epidemiology : France.
- metabolism : Respiratory Distress Syndrome, Adult.
- methods : Critical Care, Positive-Pressure Respiration.
- mortality : Respiratory Distress Syndrome, Adult.
- therapy : Respiratory Distress Syndrome, Adult.
- Adult, Analysis of Variance, Blood Gas Analysis, Female, Hemodynamics, Humans, Linear Models, Lung Compliance, Male, Middle Aged, Prone Position, Prospective Studies, Pulmonary Circulation, Radiography, Severity of Illness Index, Supine Position, Tidal Volume, Treatment Outcome.
Abstract
OBJECTIVE
To determine whether positive end-expiratory pressure (PEEP) and prone position present a synergistic effect on oxygenation and if the effect of PEEP is related to computed tomography scan lung characteristic.
DESIGN
Prospective randomized study.
SETTING
French medical intensive care unit.
PATIENTS
Twenty-five patients with acute respiratory distress syndrome.
INTERVENTIONS
After a computed tomography scan was obtained, measurements were performed in all patients at four different PEEP levels (0, 5, 10, and 15 cm H2O) applied in random order in both supine and prone positions.
MEASUREMENTS AND MAIN RESULTS
Analysis of variance showed that PEEP (p <.001) and prone position (p <.001) improved oxygenation, whereas the type of infiltrates did not influence oxygenation. PEEP and prone position presented an additive effect on oxygenation. Patients presenting diffuse infiltrates exhibited an increase of Pao2/Fio2 related to PEEP whatever the position, whereas patients presenting localized infiltrates did not have improved oxygenation status when PEEP was increased in both positions. Prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. Analysis of variance showed that prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. The decrease of the shunt related to PEEP was more pronounced in patients presenting diffuse infiltrates. A lower inflection point was identified in 22 patients (88%) in both supine and prone positions. There was no difference in mean lower inflection point value between the supine and the prone positions (8.8 +/- 2.7 cm H2O vs. 8.4 +/- 3.4 cm H2O, respectively).
CONCLUSIONS
PEEP and prone positioning present additive effects. The prone position, not PEEP, improves oxygenation in patients with acute respiratory distress syndrome with localized infiltrates.
DOI: 10.1097/01.CCM.0000094216.49129.4B
PubMed: 14668607
Affiliations:
Links toward previous steps (curation, corpus...)
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first="Xavier" last="Thirion">Xavier Thirion</name></author><author><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name></author><author><name sortKey="Sainty, Jean Marie" sort="Sainty, Jean Marie" uniqKey="Sainty J" first="Jean-Marie" last="Sainty">Jean-Marie Sainty</name></author><author><name sortKey="Papazian, Laurent" sort="Papazian, Laurent" uniqKey="Papazian L" first="Laurent" last="Papazian">Laurent Papazian</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2003">2003</date><idno type="RBID">pubmed:14668607</idno><idno type="pmid">14668607</idno><idno type="doi">10.1097/01.CCM.0000094216.49129.4B</idno><idno type="wicri:Area/Main/Corpus">000474</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000474</idno><idno type="wicri:Area/Main/Curation">000474</idno><idno type="wicri:explorRef" wicri:stream="Main" 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Michelet</name></author><author><name sortKey="Thirion, Xavier" sort="Thirion, Xavier" uniqKey="Thirion X" first="Xavier" last="Thirion">Xavier Thirion</name></author><author><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name></author><author><name sortKey="Sainty, Jean Marie" sort="Sainty, Jean Marie" uniqKey="Sainty J" first="Jean-Marie" last="Sainty">Jean-Marie Sainty</name></author><author><name sortKey="Papazian, Laurent" sort="Papazian, Laurent" uniqKey="Papazian L" first="Laurent" last="Papazian">Laurent Papazian</name></author></analytic><series><title level="j">Critical care medicine</title><idno type="ISSN">0090-3493</idno><imprint><date when="2003" type="published">2003</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Analysis of Variance (MeSH)</term><term>Blood Gas Analysis 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(MeSH)</term><term>Analyse de variance (MeSH)</term><term>Circulation pulmonaire (MeSH)</term><term>Compliance pulmonaire (MeSH)</term><term>Décubitus dorsal (MeSH)</term><term>Décubitus ventral (MeSH)</term><term>Femelle (MeSH)</term><term>France (épidémiologie)</term><term>Gazométrie sanguine (MeSH)</term><term>Humains (MeSH)</term><term>Hémodynamique (MeSH)</term><term>Indice de gravité de la maladie (MeSH)</term><term>Modèles linéaires (MeSH)</term><term>Mâle (MeSH)</term><term>Radiographie (MeSH)</term><term>Résultat thérapeutique (MeSH)</term><term>Soins de réanimation (méthodes)</term><term>Syndrome de détresse respiratoire de l'adulte (imagerie diagnostique)</term><term>Syndrome de détresse respiratoire de l'adulte (mortalité)</term><term>Syndrome de détresse respiratoire de l'adulte (métabolisme)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Ventilation à pression positive (méthodes)</term><term>Volume courant (MeSH)</term><term>Études 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Position</term><term>Tidal Volume</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de variance</term><term>Circulation pulmonaire</term><term>Compliance pulmonaire</term><term>Décubitus dorsal</term><term>Décubitus ventral</term><term>Femelle</term><term>Gazométrie sanguine</term><term>Humains</term><term>Hémodynamique</term><term>Indice de gravité de la maladie</term><term>Modèles linéaires</term><term>Mâle</term><term>Radiographie</term><term>Résultat thérapeutique</term><term>Volume courant</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To determine whether positive end-expiratory pressure (PEEP) and prone position present a synergistic effect on oxygenation and if the effect of PEEP is related to computed tomography scan lung characteristic.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>Prospective randomized study.</p></div><div type="abstract" xml:lang="en"><p><b>SETTING</b></p><p>French medical intensive care unit.</p></div><div type="abstract" xml:lang="en"><p><b>PATIENTS</b></p><p>Twenty-five patients with acute respiratory distress syndrome.</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>After a computed tomography scan was obtained, measurements were performed in all patients at four different PEEP levels (0, 5, 10, and 15 cm H2O) applied in random order in both supine and prone positions.</p></div><div type="abstract" xml:lang="en"><p><b>MEASUREMENTS AND MAIN RESULTS</b></p><p>Analysis of variance showed that PEEP (p <.001) and prone position (p <.001) improved oxygenation, whereas the type of infiltrates did not influence oxygenation. PEEP and prone position presented an additive effect on oxygenation. Patients presenting diffuse infiltrates exhibited an increase of Pao2/Fio2 related to PEEP whatever the position, whereas patients presenting localized infiltrates did not have improved oxygenation status when PEEP was increased in both positions. Prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. Analysis of variance showed that prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. The decrease of the shunt related to PEEP was more pronounced in patients presenting diffuse infiltrates. A lower inflection point was identified in 22 patients (88%) in both supine and prone positions. There was no difference in mean lower inflection point value between the supine and the prone positions (8.8 +/- 2.7 cm H2O vs. 8.4 +/- 3.4 cm H2O, respectively).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>PEEP and prone positioning present additive effects. The prone position, not PEEP, improves oxygenation in patients with acute respiratory distress syndrome with localized infiltrates.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">14668607</PMID><DateCompleted><Year>2004</Year><Month>01</Month><Day>16</Day></DateCompleted><DateRevised><Year>2016</Year><Month>11</Month><Day>24</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0090-3493</ISSN><JournalIssue CitedMedium="Print"><Volume>31</Volume><Issue>12</Issue><PubDate><Year>2003</Year><Month>Dec</Month></PubDate></JournalIssue><Title>Critical care medicine</Title></Journal><ArticleTitle>Prone position and positive end-expiratory pressure in acute respiratory distress syndrome.</ArticleTitle><Pagination><MedlinePgn>2719-26</MedlinePgn></Pagination><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To determine whether positive end-expiratory pressure (PEEP) and prone position present a synergistic effect on oxygenation and if the effect of PEEP is related to computed tomography scan lung characteristic.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">Prospective randomized study.</AbstractText><AbstractText Label="SETTING" NlmCategory="METHODS">French medical intensive care unit.</AbstractText><AbstractText Label="PATIENTS" NlmCategory="METHODS">Twenty-five patients with acute respiratory distress syndrome.</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="METHODS">After a computed tomography scan was obtained, measurements were performed in all patients at four different PEEP levels (0, 5, 10, and 15 cm H2O) applied in random order in both supine and prone positions.</AbstractText><AbstractText Label="MEASUREMENTS AND MAIN RESULTS" NlmCategory="RESULTS">Analysis of variance showed that PEEP (p <.001) and prone position (p <.001) improved oxygenation, whereas the type of infiltrates did not influence oxygenation. PEEP and prone position presented an additive effect on oxygenation. Patients presenting diffuse infiltrates exhibited an increase of Pao2/Fio2 related to PEEP whatever the position, whereas patients presenting localized infiltrates did not have improved oxygenation status when PEEP was increased in both positions. Prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. Analysis of variance showed that prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. The decrease of the shunt related to PEEP was more pronounced in patients presenting diffuse infiltrates. A lower inflection point was identified in 22 patients (88%) in both supine and prone positions. There was no difference in mean lower inflection point value between the supine and the prone positions (8.8 +/- 2.7 cm H2O vs. 8.4 +/- 3.4 cm H2O, respectively).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">PEEP and prone positioning present additive effects. The prone position, not PEEP, improves oxygenation in patients with acute respiratory distress syndrome with localized infiltrates.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gainnier</LastName><ForeName>Marc</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Service de Réanimation Médicale, Hôpitax Sud, Marseille, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Michelet</LastName><ForeName>Pierre</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Thirion</LastName><ForeName>Xavier</ForeName><Initials>X</Initials></Author><Author ValidYN="Y"><LastName>Arnal</LastName><ForeName>Jean-Michel</ForeName><Initials>JM</Initials></Author><Author ValidYN="Y"><LastName>Sainty</LastName><ForeName>Jean-Marie</ForeName><Initials>JM</Initials></Author><Author ValidYN="Y"><LastName>Papazian</LastName><ForeName>Laurent</ForeName><Initials>L</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016430">Clinical Trial</PublicationType><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Crit Care Med</MedlineTA><NlmUniqueID>0355501</NlmUniqueID><ISSNLinking>0090-3493</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Crit Care Med. 2003 Dec;31(12):2802-3</RefSource><PMID Version="1">14668618</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000704" MajorTopicYN="N">Analysis of Variance</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001784" MajorTopicYN="N">Blood Gas Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003422" MajorTopicYN="N">Critical Care</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005602" MajorTopicYN="N">France</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006439" MajorTopicYN="N">Hemodynamics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016014" MajorTopicYN="N">Linear Models</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008170" MajorTopicYN="N">Lung Compliance</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="N">Positive-Pressure Respiration</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016684" MajorTopicYN="Y">Prone Position</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011652" MajorTopicYN="N">Pulmonary Circulation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011859" MajorTopicYN="N">Radiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016683" MajorTopicYN="N">Supine Position</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013990" MajorTopicYN="N">Tidal Volume</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2003</Year><Month>12</Month><Day>12</Day><Hour>5</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2004</Year><Month>1</Month><Day>17</Day><Hour>5</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2003</Year><Month>12</Month><Day>12</Day><Hour>5</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">14668607</ArticleId><ArticleId IdType="doi">10.1097/01.CCM.0000094216.49129.4B</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country><region><li>Provence-Alpes-Côte d'Azur</li></region><settlement><li>Marseille</li></settlement></list><tree><noCountry><name sortKey="Arnal, Jean Michel" sort="Arnal, Jean Michel" uniqKey="Arnal J" first="Jean-Michel" last="Arnal">Jean-Michel Arnal</name><name sortKey="Michelet, Pierre" sort="Michelet, Pierre" uniqKey="Michelet P" first="Pierre" last="Michelet">Pierre Michelet</name><name sortKey="Papazian, Laurent" sort="Papazian, Laurent" uniqKey="Papazian L" first="Laurent" last="Papazian">Laurent Papazian</name><name sortKey="Sainty, Jean Marie" sort="Sainty, Jean Marie" uniqKey="Sainty J" first="Jean-Marie" last="Sainty">Jean-Marie Sainty</name><name sortKey="Thirion, Xavier" sort="Thirion, Xavier" uniqKey="Thirion X" first="Xavier" last="Thirion">Xavier Thirion</name></noCountry><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Gainnier, Marc" sort="Gainnier, Marc" uniqKey="Gainnier M" first="Marc" last="Gainnier">Marc Gainnier</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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